Healthcare Provider Details

I. General information

NPI: 1114939220
Provider Name (Legal Business Name): VERNER DALMOND GODWIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 E RENO AVE
OKLAHOMA CITY OK
73117-8418
US

IV. Provider business mailing address

204 BURK WAY
DEL CITY OK
73115-2012
US

V. Phone/Fax

Practice location:
  • Phone: 405-623-1454
  • Fax:
Mailing address:
  • Phone: 405-623-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6765
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: